International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39628142 "Diversity" in rhinology 641 641 EN S. Reitsma Department of Otorhinolaryngology, Amsterdam UMC, Location Academic Medical Centre, Amsterdam, The Netherlands. 3238 10.4193/Rhin24.906

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39323198 Sphenopalatine ganglion block for pain control after septoplasty: a systematic review and meta-analysis with trial sequential analysis 642 651 EN E. Albazee Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait B. AlRajhi College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia A. Alfadhli School of Medicine, Royal College of Surgeons, Dublin, Ireland A.M. Alharran College of Medicine, Arabian Gulf University, Manama, Kingdom of Bahrain M. Al-Qudah Department of Special Surgery, Division of ORL-HNS, Jordan University of Science and Technology and King Abdullah University Hospital, Irbid, Jordan 3217 10.4193/Rhin24.225 Introduction: Septoplasty corrects a deviated nasal septum (DNS) and improves nasal obstruction. Sphenopalatine ganglion block (SPGB) effectively reduces postoperative pain after septoplasty, but conclusive evidence is still lacking. This systematic review and meta-analysis aim to comprehensively evaluate the analgesic efficacy of SPGB in septoplasty patients. Methods: We systematically searched PubMed/Medline, Scopus, Web of Science, Embase, and CENTRAL from inception to April 10th, 2024. Randomized controlled trials (RCTs) were assessed using the RoB-2 tool. The primary outcomes were postoperative pain scores, analgesic consumption, surgery duration, postoperative nausea and vomiting (PONV), and patient satisfaction. Continuous data were pooled as mean difference (MD), and dichotomous data as risk ratio (RR) with a 95% confidence interval (CI) using STATA software. Additionally, trial sequential analysis (TSA) was conducted. Results: Three RCTs with 180 patients were included. Two RCTs had a 'low risk' of bias, while one RCT had 'some concerns'. The SPGB group had significantly lower postoperative pain within 24 hours compared to controls, particularly after particularly after 1-2 hours (MD = -1.85), 4-6 hours (MD = -2.02), 12 hours (MD = -2.14), and 24 hours (MD = -2.36) TSA confirmed the conclusive evidence. Analgesic use was significantly reduced in the SPGB group. No significant differences were observed in surgery duration or PONV rates between groups. Patient satisfaction was significantly higher in the SPGB group. Conclusion: SPGB demonstrates efficacy and safety in managing postoperative pain in patients undergoing septoplasty for DNS.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39484733 Recent advances in chronic rhinosinusitis: pathophysiology, treatments, and outcome measures 652 658 EN W.J. Fokkens Department of Otorhinolarynogology and head/neck surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands A.R. Sedaghat Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA M.B. Soyka Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland S. Reitsma Department of Otorhinolarynogology and head/neck surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands 3241 10.4193/Rhin24.801 This review discusses major developments in chronic rhinosinusitis. The latest papers on prevalence of the disease, the burden for patients and society, the lack of awareness, the development of patient classifications and the consequences for the management of the disease. Our discussion includes major developments in the treatment of the disease with biologics but also their limitations. Recent developments also include evolution in the goals of care, where until recently we were content with control of disease but now start to aim for remission and maybe even cure. To reach that aim we need better definitions of disease, outcomes and biomarkers to predict the optimal moment of intervention in the development of the disease. Time will tell whether earlier intervention can prevent development of the disease and later sequelae.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39254513 Do not ignore mouth breathing syndrome: respiratory functions are affected in early childhood 659 668 EN S. Atar Bese Department of Pediatric Allergy and Immunology, Aydın Adnan Menderes University, Aydın, Turkiye O. Ozdemir Department of Child Health and Diseases, Aydın Adnan Menderes University, Aydın, Turkiye G. Tuncerler Department of Pediatric Allergy and Immunology, Aydın Adnan Menderes University, Aydın, Turkiye D. Erge Department of Pediatric Allergy and Immunology, Aydın Adnan Menderes University, Aydın, Turkiye P. Uysal Department of Pediatric Allergy and Immunology, Aydın Adnan Menderes University, Aydın, Turkiye 3209 10.4193/Rhin24.133 Introduction: Impulse oscillometry (IOS) is a useful test for measuring pulmonary resistance and reactance from the early ages. We aimed to investigate the etiological factors of mouth breathing syndrome (MB), its effects on respiratory functions, and to compare the results with those of children with nasal breathing (NB). Methods: This prospective cross-sectional study investigated children aged 3-7 years with MB (n=202) and NB (n=127) admitted to the pediatric allergy clinic between January 2023-2024. The MB group was evaluated for etiological factors by means of otorhinolaryngological examination. Respiratory function tests were evaluated using IOS and were repeated two months after appropriate treatment. Results: Adenoid hypertrophy (AH-44.0%), allergic rhinitis (AR-11.3%) and AH co-existent with AR (34.6%) were the principal causes of MB. Entire airway resistance was higher, upper and lower airway reactance were lower in the MB group compared to the NB group. No difference was detected in terms of IOS parameters between the first and second visits of MB group. Upper and entire airway resistance parameters were higher in children with AH and AH co-existent with AR groups compared to the non-obstructive group. Entire airway resistance was higher, upper and lower airway reactance were lower, in children with adenoid size>50% compared to those with adenoid size mouth breathing, allergic rhinitis, adenoids, respiratory function test, pediatrics

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39323188 The impact of mepolizumab on sleep impairment in CRSwNP: post hoc analyses of SYNAPSE and MUSCA 669 680 EN J. Mullol Department of Otorhinolaryngology, Hospital Clínic Barcelona, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain W.J. Fokkens Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands S.G. Smith Clinical Sciences - Respiratory, GSK, Durham, NC, USA T. Keeley Respiratory Patient Centered Outcomes, Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK L. Zhang Respiratory Marketed Products Statistics, GSK, Warren, NJ, USA P. Howarth Global Medical Affairs, GSK, Brentford, Middlesex, UK R. H. Chan Respiratory Patient Centered Outcomes, Value Evidence and Outcomes, GSK, GSK House, Brentford, Middlesex, UK C. Bachert Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Münster, Münster, Germany; Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China 3214 10.4193/Rhin24.021 Background: The impact of mepolizumab on impaired sleep, one of the most bothersome symptoms in patients with chronic rhinosinusitis with nasal polyps (CRSwNP), is unknown. This study aimed to determine the effect of mepolizumab and impact of comorbid upper and lower airway disease and blood eosinophil count (BEC) on sleep-/fatigue-related outcomes in CRSwNP. Methods: This was an analysis of the Phase III SYNAPSE and MUSCA (NCT03085797/NCT02281318) trials of mepolizumab in patients with severe CRSwNP and severe asthma, respectively. Endpoints included change from baseline in 22-item Sino-Nasal Outcome Test (SNOT-22) sleep and fatigue domains (SYNAPSE: Weeks 24 and 52; MUSCA: Week 24) in the overall populations and post hoc subgroups (SYNAPSE: comorbid asthma, comorbid non-steroidal anti-inflammatory drug-exacerbated respiratory disease [N-ERD] and BEC; MUSCA: comorbid CRSwNP). Results: In SYNAPSE, 289/407 patients with severe CRSwNP had comorbid asthma, 108 had N-ERD, and 278 had BEC ≥300 cells/Â#181;L. In MUSCA, 105/551 patients with severe asthma had comorbid CRSwNP. Baseline sleep and fatigue scores were worse in patients with comorbid airway disease and higher BEC. Improvements from baseline in sleep and fatigue scores were greater with mepolizumab versus placebo at Week 52 in SYNAPSE (difference in least squares mean change: -2.7 [sleep], -3.4 [fatigue], and Week 24 in SYNAPSE (-1.6 and -2.2) and MUSCA (-0.8 and -1.2), with consistent results across comorbidity and BEC subgroups. Conclusion: Mepolizumab improves sleep and fatigue in severe CRSwNP, irrespective of comorbid airway disease and BEC, with consistent effects in severe asthma with and without comorbid CRSwNP.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39158581 Adherence to olfactory training improves orthonasal and retronasal olfaction in post-COVID-19 olfactory loss 681 688 EN P. Boscolo-Rizzo Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy T. Hummel Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University of Dresden, Dresden, Germany A. Menini Neurobiology Group, SISSA, Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy A. Maniaci Faculty of Medicine and Surgery, University of Enna "Kore", Enna, Italy F. Uderzo Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy L. Bigolin Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy G. Tirelli Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy 3206 10.4193/Rhin24.233 Background: Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of olfactory training (OT) on orthonasal and retronasal olfactory function in a cohort of individuals with persistent post-COVID-19 OL.Methodology: Participants with post-COVID-19 olfactory impairment underwent 4 months of OT, self-assessing their smell perception and undergoing comprehensive psychophysical evaluation of orthonasal and retronasal olfaction at baseline and after training. Orthonasal olfactory function was assessed using the extended Sniffin' Sticks test battery. Retronasal olfactory function was tested with powdered aromas. Results: Among 114 participants with post-COVID-19 olfactory loss, adherence to OT was 60%. In adherents, the average increase in composite TDI score was 6.0 points compared to 2.6 points in non-adherents. Fifty-seven percent of adherent participants achieved a clinically significant improvement in TDI score (≥5.5 points), compared to 22% of non-adherents. In retronasal olfactoryidentification, 56% of adherents achieved a clinically significant improvement (≥4 points), compared to 16% of non-adherents.Conclusion: Adherence to a 4-month OT regimen can yield clinically meaningful improvements in both orthonasal and retronasal olfactory function among individuals with persistent post-COVID-19 olfactory dysfunction.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39254606 Predictive model for postoperative unrecovered olfactory function in CRSwNP patients with olfactory disorder 689 699 EN J.Y. Chen Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China X. Wang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China X. Luo Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China F. Jian Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China W. Zhou Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China Z. Xiao Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China J.H. Chen Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China P. Fang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China S. Wu Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Q. Liu The Biotherapy Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China X. Huang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China; Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Z. Shi Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Q. Yang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China; Naso-Orbital-Maxilla and Skull Base Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Zhang Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Department of Allergy, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, China; Key Laboratory of Airway Inflammatory Disease Research and Innovative Technology Translation, Guangzhou, China 3210 10.4193/Rhin23.475 Background: Olfactory disorder (OD) is a prevalent and challenging symptom in chronic rhinosinusitis with nasal polyps (CRSwNP). This study aims to investigate the risk factors and develop a predictive model for poor olfactory prognosis in CRSwNP patients with OD after endoscopic sinus surgery (ESS). Method: Seventy-eight CRSwNP patients with OD who underwent ESS were enrolled. Preoperative and 6-month-postoperative olfactory function were assessed using Sniffin’ Sticks. Receiver operating characteristics (ROC) curves were constructed to set the cutoff points. Risk factors were determined by logistic models. A power analysis was conducted to evaluate the sample size. Results: Overall, 66.7% of CRSwNP patients had unrecovered olfaction after surgery. Patients with unrecovered olfaction displayed higher preoperative threshold-discrimination-identification (TDI) score, lower Questionnaire for Olfactory Disorders-Negative Statements (QOD-NS) score, lower total olfactory cleft score (TOCS), and fewer tissue eosinophils than those of the improved/recovered group. QOD-NS≤5.0, preoperative TOCS≤4.5 and tissue eosinophil count≤8.3 were independent risk factors for unrecovered olfaction. Based on these variables, a predictive model was developed. The area under the ROC curve for the model was 0.845, and the optimal cutoff value was 2.0 points, with a sensitivity of 82.7% and specificity of 80.8%. Conclusions: Low levels of QOD-NS score (preoperative), TOCS (preoperative) and tissue eosinophil count are independent risk factors for short-term unrecovered olfaction in CRS patients with OD postoperatively. The predictive model developed here is practical and convenient for the early identification of poor prognosis of OD, enabling early additional intervention.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39254484 SNOT-22 in general population, a Spanish cohort study with an updated meta-analysis 700 709 EN L.N. Piñeros-García Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Spain N.I. González-Sánchez Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Spain C. Calvo- Henrique Otorhinolaryngology Department, Hospital Complex and University of Santiago de Compostela, Spain; Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) study group; Translational Research in Airway Diseases, IDIS-Santiago de Compostela, Spain M.J. Rojas-Lechuga Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain C. Hopkins Otorhinolaryngology Department, Guy's Hospital, London, UK J. Mullol Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain I. Alobid Rhinology and Skull Base Unit, Otorhinolaryngology Department, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain 3208 10.4193/Rhin24.233 Background: Olfactory loss (OL) has emerged as one of the most prevalent and debilitating symptoms of SARS-CoV-2 infection and long-COVID-19. The present prospective observational study aimed to evaluate the efficacy of olfactory training (OT) on orthonasal and retronasal olfactory function in a cohort of individuals with persistent post-COVID-19 OL. Methodology: Participants with post-COVID-19 olfactory impairment underwent 4 months of OT, self-assessing their smell perception and undergoing comprehensive psychophysical evaluation of orthonasal and retronasal olfaction at baseline and after training. Orthonasal olfactory function was assessed using the extended Sniffin' Sticks test battery. Retronasal olfactory function was tested with powdered aromas. Results: Among 114 participants with post-COVID-19 olfactory loss, adherence to OT was 60%. In adherents, the average increase in composite TDI score was 6.0 points compared to 2.6 points in non-adherents. Fifty-seven percent of adherent participants achieved a clinically significant improvement in TDI score (≥5.5 points), compared to 22% of non-adherents. In retronasal olfactory identification, 56% of adherents achieved a clinically significant improvement (≥4 points), compared to 16% of non-adherents. Conclusion: Adherence to a 4-month OT regimen can yield clinically meaningful improvements in both orthonasal and retronasal olfactory function among individuals with persistent post-COVID-19 olfactory dysfunction.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39323187 Technical skills of endoscopic sinus surgery for performance assessment using the Delphi methodology 710 715 EN M.J. Guldager Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark S.A. Wuyts Andersen Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark J. Melchiors Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark E. Prokopakis Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Crete, Greece C. Hopkins ENT Department, Guy’s Hospital, London, United Kingdom C. von Buchwald Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Denmark 3213 10.4193/Rhin23.371 Background: In surgical residency, competence has traditionally been defined by a specified number of surgical procedures. Modern advances in medical education and surgical fellowships have challenged this approach. It is widely accepted that a definition of a skill set, enabling a systematic, competency-based assessment is mandatory in surgical education. Methodology: We conducted an international Delphi study with panelists from the European Rhinologic Society, representing 27 countries. Through four rounds, the panel reached consensus on the phrasing of an assessment tool-, for the technical skills of endoscopic sinus surgery (ESS). Results: Thirty panelists participated throughout the study. The median age of the panelists was 54 years (range 31-66 years) with a median experience of 25 years (range 6-40 years). All were experts in the field of endoscopic sinus surgery. Consensus was reached. The final assessment tool consists of 21 items with descriptive anchors. Conclusion: The assessment tool, European Endoscopic Sinus Surgery â€" Technical Skills Assessment (EE-TSA), enables a competency-based approach to acquiring and maintaining essential elements of endoscopic sinus surgery. The international Delphi panel makes the tool internationally applicable. Further research should gather validity evidence for EE-TSA, enhancing the assessment of ESS by setting a pass/fail-standard ultimately improving surgical outcomes and patient safety.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39323199 Correlations of pre- and post-operative symptoms with cytokines in different phenotypes and endotypes of chronic rhinosinusitis 716 725 EN S. A. Han Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea H. Cha Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea J-A. Park Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea A. Jo Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Republic of Korea D.W. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Republic of Korea H.T. Ryu Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Republic of Korea S.K. Yang Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea S-N. Hong Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Centre, Seoul, Republic of Korea J.Y. Kim Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea S.H. Oh Department of Biostatistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul, Republic of Korea D.W. Kim Department of Otorhinolaryngology-Head and Neck Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, Republic of Korea; Sensory Organ Research Institute, Seoul National University Medical Research Centre, Seoul, Republic of Korea 3216 10.4193/Rhin23.215 Background: Recognising inflammatory endotypes in chronic rhinosinusitis (CRS) has become more important, especially with the advent of biological treatments. In this study, we investigated the correlations of pre- and post-operative symptoms with cytokine positivity in different endotypes and phenotypes of CRS. Methodology: In total, 102 patients undergoing routine functional endoscopic sinus surgery were enrolled. The endotype classification (type 1, 2, or 3 CRS) was defined based on positivity for interferon-γ, interleukin (IL)-5, or IL-17 respectively, in sinonasal tissue samples. Clinical symptom scores were evaluated pre- and post-operatively using the 22-item Sinonasal Outcome Test and its four symptom subdomains: sleep, nasal, otologic/facial symptoms, and emotional function. Symptoms were compared between endotypes and phenotypes, and exploratory factor analysis (EFA) based on principal component analysis (PCA) was performed. The correlations of cytokine levels with baseline symptoms and changes in symptoms after 1 year were analysed. Results: Symptoms in the otologic/facial pain category were associated with non-type 2 endotypes in PCA and confirmatory analysis. Non-type 2 CRS patients exhibited significantly more improvement in facial symptoms 1 year after surgery. Neutrophil-associated cytokines, such as IL-17, matrix metalloproteinase 9, and myeloperoxidase, were significantly correlated with baseline otologic/facial pain symptoms and changes in those symptoms after surgery. Conclusions: Otologic/facial pain symptoms may be indicative of non-type 2 endotypes. Neutrophil-associated cytokines, such as IL-17, MMP-9, and MPO, were significantly correlated with these symptoms. The establishment of links between specific symptoms and certain cytokines may help use and develop biological therapies for CRS.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39365556 IL-17A disrupts the nasal mucosal epithelial barrier in patients with chronic rhinosinusitis by activating the ERK/STAT3 pathway 726 738 EN H. Wu Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Li Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China X. Li Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China W. Huang Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Z. Huang Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China X. Lai Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China J. Ma Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Jiang Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China Y. Zhang Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China L. Chang Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China G. Zhang Department of Otorhinolaryngology-Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China 3226 10.4193/Rhin24.127 Background: The mucosal epithelial barrier, the first line of immune defense, is vulnerable to allergens, pathogens, and inflammatory cytokines, contributing to CRS development. Our previous studies found high interleukin-17A(IL-17A) expression correlated with CRS severity and low glucocorticoid efficacy. The role of IL-17A in disrupting the nasal mucosal epithelial barrier leading to CRS remains unclear. We aimed to investigate how IL-17A promoting epithelial barrier damage and identify new treatment targets for CRS. Methodology: Nasal tissue samples from 36 CRSwNP, 34 CRSsNP, and 39 controls were examined for the expression of IL-17A and tight junction (TJ) proteins using qRT-PCR, immunohistochemistry and immunofluorescence. The integrity of TJs and signaling pathways activation were observed using western blot, immunofluorescence, TEER and FITCâ€"FD4, transmission electron microscopy before and after IL-17A stimulation in human primary nasal epithelial cells (hNECs). Concurrently, studies were also conducted in an CRS mouse model induced by anti-IL-17A neutralizing antibody administration. Results: TJs expression in the nasal mucosa of CRS patients was lower than in controls. IL-17A stimulation reduced TJs expression and TEER while increasing hNECs permeability. Inhibition of the (ERK/STAT3) pathway reversed the downregulation of TJs and the disruption of the epithelial barrier induced by IL-17A stimulation. In the CRS mouse model, anti-IL-17A antibody treatment rescued the nasal mucosal epithelial barrier. Conclusions: IL-17A disrupts the nasal mucosal epithelial barrier by activating the ERK/STAT3 pathway in patients with CRS.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39365558 Blood transcriptomics reveal systemic eosinophilic and neutrophilic inflammation patterns in patients with nasal polyps 739 749 EN W. Liu Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China K. Wang Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China H. Guan Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China L. Ma Department of Otorhinolaryngology, the University of Hong Kong-Shenzhen Hospital, Shenzhen, China Y. Cui Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China C. Liu Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China J. Shi Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Y. Fan Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China Y. Sun Department of Otolaryngology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China 3225 10.4193/Rhin24.248 Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic sinonasal disease characterized by heterogeneous inflammation. However, the presence of systemic inflammation heterogeneity in CRSwNP patients remains unknown. This study aims to profile transcriptomic alterations in the blood of CRSwNP patients and characterize the CRSwNP heterogeneity based on blood transcriptomic biomarkers. Methodology: Patients with CRSwNP were prospectively recruited from three hospitals and chronologically divided into exploratory (n=123) and independent validation (n=46) cohorts. Transcriptomic profiles were generated by whole blood mRNA sequencing and subjected to patient clustering, differential expression, and pathway analysis. Differences in immune pattern and clinicopathologic features between clusters were assessed. A transcriptomic signature was defined and applied to an independent cohort to validate the findings. Results: CRSwNP patients showed diverse blood transcriptomic profiles versus healthy controls, or when stratified by tissue and blood eosinophils and asthma comorbidity. Transcriptome-wide correlation analysis revealed a transcriptional signature associated with blood eosinophil levels, consisting of nine T2-related genes (CLC, SIGLEC8, ALOX15, IL5RA, PTGDR2, CCL23, CCR3, EPX and IL1RL1). Three distinct clusters with differing systemic eosinophilic and neutrophilic inflammation patterns and asthma comorbidity were identified based on transcriptomic profiling of T2 and T1/3-related blood biomarkers. A 36-gene signature was developed by machine learning and accurately predicted the three CRSwNP subtypes. Validation on an independent cohort confirmed the prediction robustness. Conclusions: There is heterogeneous systemic inflammation associated with eosinophilic and neutrophilic patterns in patients with CRSwNP. Endotyping based on blood transcriptomic biomarkers might lead to more personalized treatment strategies for CRSwNP in the future.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39140195 Differential proteomic expression in non-functional pituitary neuroendocrine tumours and pituitary glands 750 758 EN N.G. Candy Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia M. Ramezanpour Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia G. Bouras Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia N. Chegeni Flinders Proteomic Facility, Department of Human Physiology, Flinders University, Bedford Park, Australia T. Chataway Flinders Proteomic Facility, Department of Human Physiology, Flinders University, Bedford Park, Australia R.J. Ormsby Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia A.K. Jukes Flinders Proteomic Facility, Department of Human Physiology, Flinders University, Bedford Park, Australia S. Vreugde Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia P-J. Wormald Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia A.J. Psaltis Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia 3205 10.4193/Rhin24.216 Introduction: Pituitary neuroendocrine tumours (PitNETs) are common accounting for 10 to 25 % of all intracranial tumours. This project describes the feasibility of developing a novel membrane-based biomarker that could be used for fluorescent guided surgery. The aim was to catalogue the differential expression of membrane proteins between non-functional PitNETs and pituitary glands. Methodology: Ten pituitary gland tissue specimens were obtained from the National Institute of Health (NIH) NeuroBio-Bank and twenty non-functional PitNETs were obtained from the Northwestern University Nervous System Tumour Bank. Mass spectrometry analysis using an Orbitrap Fusion Lumos Tribrid Mass Spectrometer linked to a Dionex Ultimate 3000 UPLC system was undertaken. Data Dependent Acquisition Mass Spectrometry and Data Independent Acquisition Mass Spectrometry was then completed. Pathway enrichment analysis was performed using clusterProfiler v4.6.0. Functional enrichment analysis was conducted using Gene Ontology terms and Reactome pathways. Results: Differential expression analysis between the two groups revealed a total of 2110 significant differently expressed proteins (DEPs), with 1387 of these also having a Log2 fold change either greater than 1, or less than -1. Of the 2110 DEPs, 925 were upregulated in tumours compared to control, while 1185 were downregulated. Conclusion: We have demonstrated a proteomic comparison between non-functional PitNETs and normal pituitary glands. These results demonstrate differences consistent with contemporary literature but shows that NOTCH3 and PTPRJ are up-regulated in non-functional PitNETs compared to pituitary glands.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39018522 A phenomenon not to be missed: delayed postoperative cerebrospinal fluid rhinorrhea following no identifiable intraoperative leak in sellar surgery 759 762 EN R.S. Kshirsagar Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA J.G. Eide Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA A. Abiri Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA K.P. Asmaro Department of Neurosurgery, Stanford Hospital, Stanford, CA, USA P. Filip Department of Otolaryngology-Head and Neck Surgery, The Mount Sinai Hospital/Icahn School of Medicine at Mount Sinai, New York, NY, USA D. Pangal Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA J. Ruzevick Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA N.D. Adappa Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA P.S. Batra Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA M.S. Bergsneider Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA J.R. Craig Henry Ford Health, Department of Otolaryngology-Head and Neck Surgery, Detroit, MI, USA J.C. Fernandez-Miranda Department of Neurosurgery, Stanford Hospital, Stanford, CA, USA P.A. Gardner Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA M.S. Grady Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA A.A. Halderman Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA F.P.K. Hsu Department of Neurological Surgery, University of California Irvine, Orange, CA, USA A. Mohyeldin Department of Neurological Surgery, University of California Irvine, Orange, CA, USA J.N. Palmer Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA P. Papagiannopoulos Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA C.H. Snyderman Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA B.A. Tajudeen Department of Otorhinolaryngology - Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA E.W. Wang Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA M.B. Wang Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA G. Zada Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA G.A. Zenonos Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA E.C. Kuan Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, CA, USA; Department of Neurological Surgery, University of California Irvine, Orange, CA, USA 3194 10.4193/Rhin24.175

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39115982 Characterization of the ciliary beating efficiency in primary diffuse chronic rhinosinusitis 763 765 EN M. Renaud INSERM, U955, Créteil, France; CNRS, EMR 7000, Créteil, France; Université Paris-Est Créteil, Faculté de Santé, Créteil, France; AP-HP, Hôpital Henri Mondor, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Créteil, France A. Venkatasamy IHU (Institut Hospitalo-Universitaire), Strasbourg, France E. Escudier Inserm U933, Paris, France; AP-HP, Hôpital Armand-Trousseau, Service de Génétique et d’Embryologie Médicale, Paris, France R. Mitri-Frangieh INSERM, U955, Créteil, France;CNRS, EMR 7000, Créteil, France; Centre Hospitalier Intercommunal de Créteil, Service d’Anatomopathologie, Créteil, France M. Filoche INSERM, U955, Créteil, France; CNRS, EMR 7000, Créteil, France; Université Paris-Est Créteil, Faculté de Santé, Créteil, France; Institut Langevin, ESPCI, Université PSL, CNRS, Paris, France V. Fournier INSERM, U955, Créteil, France; CNRS, EMR 7000, Créteil, France; Université Paris-Est Créteil, Faculté de Santé, Créteil, France J-F. Papon INSERM, U955, Créteil, France;CNRS, EMR 7000, Créteil, France;AP-HP, Hôpital Bicêtre, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Le Kremlin-Bicêtre, France A. Coste INSERM, U955, Créteil, France; CNRS, EMR 7000, Créteil, France; Université Paris-Est Créteil, Faculté de Santé, Créteil, France; AP-HP, Hôpital Henri Mondor, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Créteil, France; Centre Hospitalier Intercommunal de Créteil, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Créteil, France B. Louis INSERM, U955, Créteil, France; CNRS, EMR 7000, Créteil, France; Université Paris-Est Créteil, Faculté de Santé, Créteil, France E. Bequignon INSERM, U955, Créteil, France; CNRS, EMR 7000, Créteil, France; Université Paris-Est Créteil, Faculté de Santé, Créteil, France; AP-HP, Hôpital Henri Mondor, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Créteil, France; Centre Hospitalier Intercommunal de Créteil, Service d’Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Créteil, France 3202 10.4193/Rhin24.101 Ciliary dysfunction may result in chronic airway inflammation and infection causing injury and structural changes to the airway epithelium, leading to a variety of diseases, like bronchiectasis and primary diffuse chronic rhinosinusitis (CRS). Currently, ciliary beating analysis has mainly been studied through the measure of the ciliary beating frequency (CBF) by high-speed digital video microscopy (HSDV). However, a normal CBF has been described in different forms of primary and acquired ciliary dyskinesia.

International Rhinologic Society Rhinology 0300-0729 62 6 2024 12 1 39120428 The value of beta trace protein in CSF-leakage detection confirmed by endoscopic fluorescein evaluation 766 768 EN M. Habenbacher Department of Otorhinolaryngology, Medical University of Graz, Austria D. Sebastnik Department of Otorhinolaryngology, Medical University of Graz, Austria U. Moser Department of Otorhinolaryngology, Medical University of Graz, Austria A. Andrianakis Department of Otorhinolaryngology, Medical University of Graz, Austria P. Kiss Department of Otorhinolaryngology, Medical University of Graz, Austria M. Alsukayt Department of Otorhinolaryngology, Security Forces Hospital â€" Riyadh, Saudi Arabia J. Pock Department of Otorhinolaryngology, Medical University of Graz, Austria K. Walla Department of Otorhinolaryngology, Medical University of Graz, Austria E. Maitz Department of Otorhinolaryngology, Medical University of Graz, Austria P.V. Tomazic Department of Otorhinolaryngology, Medical University of Graz, Austria 3204 10.4193/Rhin24.160 Cerebrospinal fluid (CSF) leaks originating from defects within the anterior and middle cranial fossa typically manifest as unilateral clear watery rhinorrhea. Continuous CSF leakage mandates surgical repair due to the risk of meningitis and brain abscess. It can be categorized based on its underlying etiology into traumatic, iatrogenic and non-traumatic CSF leaks.